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. 2019 Jun 20;11(2):7963.
doi: 10.4081/or.2019.7963. eCollection 2019 May 23.

Single versus separate implant fixation for concomitant ipsilateral femoral neck and shaft fractures: A systematic review

Kunal Mohan  1   2 , Prasad Ellanti  1 , Helen French  2 , Niall Hogan  1 , Tom McCarthy  1
Affiliations

Single versus separate implant fixation for concomitant ipsilateral femoral neck and shaft fractures: A systematic review

Kunal Mohan et al. Orthop Rev (Pavia). .

Abstract

Concomitant ipsilateral femoral neck and shaft fractures are uncommon, occurring in 1-9% of femoral shaft fractures. While this injury typically occurs in young patients following high-energy trauma, little consensus has been established regarding the optimal fixation approach. A multitude of treatment strategies exist, with limited evidence as to which is more favorable. The aim of this study was to appraise current evidence, comparing management with either one single or separate devices for both fractures. A systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between 1992 and 2018 comparing the rate of postoperative nonunion, malunion, delayed union, avascular necrosis, infection or reoperation between at least one method of single device fixation and one method of separate device fixation were included. Six non-randomized cohort studies assessing 173 patients were suitable for inclusion, each comparing single device cephalomedullary nail fixation of both fractures with a combination of devices. All patients presented following high-energy trauma, at a median age of 32 years. While low complication rate and favorable outcomes were found across both groups, no significant difference could be inferred between either treatment strategy. This injury continues to occur in the traditionally described patient group, and results in acceptable postoperative outcomes. A paucity of randomized studies limits the ability to recommend a single or separate device treatment approach, and as such prospective, randomized trials with adequately powered sample sizes are required to definitively compare surgical management strategies in this rare but complex injury.

Keywords: Concomitant; Femur; Ipsilateral; Neck; Shaft.

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Conflict of interest statement

Conflict of interest: the authors declare no potential conflict of interest.

Figures

Figure 1.
Figure 1.
Database Search Strategy.
Figure 2.
Figure 2.
Study Selection Flow Diagram.
See this image and copyright information in PMC

References

    1. Koval KJ, Zuckerman JD. Hip Fractures: I. Overview and Evaluation and Treatment of Femoral-Neck Fractures. J Am Acad Orthop Surg 1994;2:141-9. - PubMed
    1. Nikolaou VS, Stengel D, Konings P, et al. Use of femoral shaft fracture classification for predicting the risk of associated injuries. J Orthop Trauma 2011;25:556-9. - PubMed
    1. Innocenti M, Civinini R, Carulli C, Matassi F. Proximal femural fractures: epidemiology. Clin Cases Min Bone Metabol 2009;6:117-9. - PMC - PubMed
    1. Adnan RM ZM, Amin J, Khan R, et al. Frequency of femoral fractures; comparison in patients less than and more than 40 years of age. Prof Med J 2012; 19:11-4.
    1. Somersalo A, Paloneva J, Kautiainen H, et al. Incidence of fractures requiring inpatient care. Acta Orthop 2014; 85:525-30. - PMC - PubMed